Laparoscopic Umbilical Hernia Repair Research Articles

General anaesthesia for laparoscopic umbilical hernia repair in a patient with pseudocholinesterase deficiency: a case report

Pseudocholinesterase deficiency is a condition that causes prolonged muscle weakness when succinylcholine or mivacurium is used as a neuromuscular blocking agent. It can be either inherited or acquired. The practice of not using these two muscle relaxant agents may suggest that PED is not a significant problem for general anesthesia. This case report describes the successful discharge of a patient with a preexisting diagnosis of PED who underwent laparoscopic umbilical hernia repair under GA with neuromuscular monitoring without complications.

Safety of Concomitant Umbilical Hernia Repair during Abdominoplasty: A Propensity Score Matched Analysis

PURPOSE: Over 97,000 abdominoplasties were performed in 2020 in the United States alone. Patients seeking a cosmetic abdominoplasty often have concurrent umbilical hernias stemming from shared risk factors for fascial and skin laxity. Optimum management and the safety of performing umbilical hernia repair during the same operation as an abdominoplasty is not well described. In this context, we compared the complication rates of performing an abdominoplasty with an umbilical hernia with abdominoplasty alone. Further we share our technique for umbilical hernia repair. METHOD: We performed a retrospective propensity score-matched cohort study of patients (n=271) who underwent an abdominoplasty at Massachusetts General Hospital between January 2014 and December 2020 by the senior author. Patients with panniculectomy were excluded to give a more homogenous population. Patients who underwent repair of an umbilical hernia at the time of the abdominoplasty were identified. One-to-one nearest-neighbor propensity score matching was conducted to adjust for differences in patient baseline covariates. The primary outcome was any post-operative complication. Secondary outcomes included umbilical necrosis, skin flap necrosis, hematoma, venous thromboembolism, seroma, infection, and hernia recurrence. RESULTS: One-to-one propensity-score matching yielded 63 patients in each exposure group (126 patients total) with the distribution of observed baseline covariates closely aligned. If an umbilical hernia was present, a fascial slit was made inferior or superior to the umbilicus, the hernia contents were reduced if needed, and the fascial edges were approximated with one to three 0-Ethibond sutures from underneath. Within the matched cohort, there was no significant difference in total complication rates (abdominoplasty alone 8% (n=5) vs. abdominoplasty with hernia repair 6% (n=4) p=1.00). Similarly, there were no significant differences in any of the secondary outcomes (p>0.05). Specifically, there were no cases of abdominal skin necrosis or umbilical necrosis in either group. CONCLUSION: Performing umbilical hernia repair during the same operation as an abdominoplasty is safe without significantly increasing risk to the patient. Avoiding the dissection of or through the umbilical stalk may help provide adequate blood supply for survival. Future prospective studies are needed to evaluate patient-reported and long-term outcomes. REFERENCES: 1. ASPS Plastic Surgery Statistics Report 2020. Accessed 3/1/2022. 2. Person H, Mojallal A, Braye F, Shipkov H. Techniques of Concomitant Abdominoplasty and Umbilical Hernia Repair: A Review. Aesthet Surg J. Jun 14 2021;41(7):NP831-NP839. doi:10.1093/asj/sjab094 3. van Schalkwyk CP, Dusseldorp JR, Liang DG, Keshava A, Gilmore AJ, Merten S. Concomitant Abdominoplasty and Laparoscopic Umbilical Hernia Repair. Aesthet Surg J. Nov 12 2018;38(12):NP196-NP204. doi:10.1093/asj/sjy100

Laparoscopic Umbilical Hernia repair in male patients with abdominal obesity.

Objective:Obesity is a global health problem, and obese patients are subject to developing abdominal wall hernias. There are few prospective studies comparing the laparoscopic method of umbilical hernia mesh repair between abdominal obesity patients and normal abdominal waist patients. The aim of this study was to evaluate the short-term outcomes (operative time, early complications and hospital stay) in the patients having laparoscopic hernia repair with abdominal obesity.Methods:This prospective cohort study was conducted at King Fahad Hospital Hofuf, Kingdom of Saudi Arabia from June 2014 to June 2021. Fifty four (54) adult male patients with umbilical hernia were included in this study. The patients were divided into two groups: Group-A: Patients with abdominal obesity (n=26), and Group-B: Patients without abdominal obesity (n=28). All the patients underwent laparoscopic repair of umbilical hernia. The patients with abdominal obesity were defined as those having an abdominal girth more than 102 centimeters.Results:No significant differences were observed as related to age, co-morbidity and risk factors between the two groups. The statistically significant difference between the two groups observed was related to the mean operative time and the mean hospital stay.Conclusion:Laparoscopic umbilical hernia repair can be safely performed in abdominal obesity in male patients without an additional risk of complications.

Surgeon Volume and Risk of Reoperation after Laparoscopic Primary Ventral Hernia Repair: A Nationwide Register-Based Study

Repairs of primary ventral hernias are common procedures but are associated with high recurrence rates. Therefore, it is important to investigate risk factors for recurrence to optimize current treatments. The aim of this study was to assess the impact of annual surgeon volume on the risk of reoperation for recurrence after primary ventral hernia repair. We conducted a nationwide register-based study with data from the Danish Ventral Hernia Database and the Danish Patient Safety Authority's Online Register linked via surgeons' authorization identification. We included patients 18 years and older, undergoing umbilical or epigastric hernia repair between 2011 and 2020. Annual surgeon volume was categorized into ≤ 9, 10 to 19, 20 to 29, and ≥ 30 cases. Patients were followed until reoperation, death, emigration, or end of the study period. We included 7,868 patients who underwent laparoscopic (n= 1,529 [19%]), open mesh (n= 4,138 [53%]), or open nonmesh (n= 2,201 [28%]) repair. There was an increased risk of reoperation after laparoscopic umbilical or epigastric hernia repair for surgeons with ≤ 9 (hazard ratio 6.57; p= 0.008), 10 to 19 (hazard ratio 6.58; p= 0.011), and 20 to 29 (hazard ratio 13.59; p= 0.001) compared with ≥ 30 cases/y. There were no differences in risk of reoperation after open mesh and open nonmesh repair in relation to annual surgeon volume. There was a significantly higher risk of reoperation after laparoscopic primary ventral hernia repair performed by lower-volume surgeons compared with high-volume surgeons. Additional research investigating how sufficient surgical training and supervision are ensured is indicated to reduce risk of reoperation after primary ventral hernia repair.

Open versus laparoscopic umbilical and epigastric hernia repair: nationwide data on short- and long-term outcomes.

It is unclear whether an open or laparoscopic approach results in the best outcomes for repair of umbilical and epigastric hernias. The aim of the study was to evaluate the rates of 90-day readmission and reoperation for complication, together with rate of operation for recurrence after either open or laparoscopic mesh repair for primary umbilical or epigastric hernias with defect widths above 1cm. A merge of data between the Danish Hernia Database and the National Patient Registry provided data from 2007 to 2018 on perioperative information, 90-day readmission, 90-day reoperation for complication, and long-term operation for hernia recurrence. A total of 6855 patients were included, of whom 4106 (59.9%) and 2749 (40.1%) patients had an open or laparoscopic repair, respectively. There were significantly more patients readmitted with a superficial surgical site infection 2.5% (102/4106) after open repair compared with laparoscopic repair (0.5% (15/2749), P < 0.001. The 90-day reoperation rate for complications was significantly higher for open repairs 5.0% (205/4106) compared with laparoscopic repairs 2.7% (75/2749), P < 0.001. The incidence of a reoperation for a severe condition was significantly increased after laparoscopic repair 1.5% (41/2749) compared with open repair 0.8% (34/4106), P = 0.010. The 4-year cumulative incidence of operation for hernia recurrence was 3.5% after open and 4.2% after laparoscopic repairs, P = 0.302. Recurrence rates were comparable between open and laparoscopic repair of umbilical and epigastric hernias. Open repair was associated with a significantly higher rate of readmission and reoperation due to surgical site infection, whereas the rate of reoperation due to a severe complication was significantly higher after laparoscopic repair.

Closure of the fascial defect during laparoscopic umbilical hernia repair: a randomized clinical trial

The objective of the study was to analyse patient-reported outcome measures (PROMs), seroma formation, long-term recurrence and chronic pain after closure of the fascial defect in patients undergoing laparoscopic umbilical hernia mesh repair. This was a randomized double-blinded trial in patients undergoing elective laparoscopic umbilical hernia repair comparing sutured closure of the fascial defect before intraperitoneal onlay mesh (IPOM) repair with a no-closure IPOM repair. Postoperative pain, movement limitations, discomfort and fatigue were registered before surgery and on postoperative days 1-3, 7 and 30. Seroma formation, quality of life and cosmesis were assessed at day 30, and at 2 years of follow-up. Recurrence (clinical and reoperation) and chronic pain were assessed after 2 years. Eighty patients were randomized. Median defect sizes in closure and no-closure groups were 2·5 (range 1·5-4·0) and 2·5 (2·0-5·5)cm respectively (P=0·895). There were no significant differences in early and late postoperative pain or in any other early or late PROMs, except for early fatigue which was higher in the closure group (P=0·011). Seroma formation after 30 days was significantly reduced after closure (14 of 40; 35 (95 per cent c.i. 22 to 51) per cent) compared with no closure (22 of 38; 58 (42 to 72) per cent) (P=0·043). Cumulative recurrence after 2 years was lower in the closure group: 5 of 36 (7 (3 to 17) per cent) versus 12 of 37 (19 (10 to 33) per cent) for no closure (P=0·047). Closure of the fascial defect in laparoscopic umbilical hernia IPOM repair significantly reduced early seroma formation and long-term recurrence without inducing side-effects such as pain, or other early or late PROMs. Registration number: NCT01962480 ( https://www.clinicaltrials.gov).

Updated outcomes of laparoscopic versus open umbilical hernia repair in patients with obesity based on a National Surgical Quality Improvement Program review.

Currently, there's not a well-accepted optimal approach for umbilical hernia repairin patients with obesity when comparing laparoscopic umbilical hernia repair (LUHR) versus open umbilical hernia repair (OUHR). The objective of this study was to evaluate if there's a difference in postoperative complications after LUHR versus OUHR with the goal of indicating an optimal approach. A retrospective analysis was completed using the 2016 National Surgical Quality Improvement Program (NSQIP) database to identify patients with obesity (Body Mass Index (BMI) ≥ 30kg/m2) who underwent LUHR or OUHR. Patients were divided into OUHR and LUHR groups, and post-operative outcomes were compared, focusing on wound complications. A total of 12,026 patients with obesity who underwent umbilical hernia repair were identified; 9695 underwent OUHR, while 2331 underwent LUHR. The LUHR group was found to have a statistically significant higher BMI (37.5kg/m2 vs. 36.1kg/m2; p < 0.01) andhigher incidence of diabetes mellitus requiring therapy (18.4% vs. 15.8%; p < 0.01), hypertension (47.5% vs. 43.8%; p < 0.01), and current smoker status (18.6% vs. 16.5%; p < 0.02). Superficial surgical site infection (SSI) was significantly higher in the OUHR group (1.5% vs. 0.9%; p < 0.03), and there was a trend towards higher deep SSI in the OUHR group (0.3% vs. 0.5%; p = 0.147). There was no difference in organ space SSI, wound disruption, or return to OR. On logistic regression, composite SSI rate (defined as superficial, deep, and organ space SSIs) was significantly increased in the OUHR group (p < 0.01). Predictive factors significantly associated with increased morbidity included female gender and higher BMI. In patients with obesity, even though the LUHR group had an overall higher BMI and higher rates of diabetes, hypertension, and current smoking status, they experienced decreased post-operative wound complications compared to the OUHR group.

Abdominoplasty with simultaneous laparoscopic umbilical hernia repair: A practical approach to preserve the umbilical vascularization

Umbilical necrosis is a well-known complication of abdominoplasty, the risk of this complication can be increased when an associated umbilical hernia requires further dissection in peri-umbilical region, potentially leading to umbilical devascularisation. Multiple minimally invasive open techniques were described to avoid this problem. The combined approach of abdominoplasty with laparoscopic umbilical hernia repair is one promising solution to avoid devascularising the umbilicus. A retrospective evaluation of patients who underwent concomitant abdominoplasty with laparoscopic umbilical hernia repair from 2007 to 2017 was carried out. All patients were followed up and evaluated for complications, including the incidence of umbilical skin necrosis. A total of 47 patients were included in this study. The average operative duration was 3.3hours with an average hospital stay of 2.5 days. No cases of postoperative umbilical necrosis were encountered. A mean follow-up period was 2.4 years showed no cases of hernia or rectus abdominis diastasis recurrence. Minor complications included 4 cases of dehiscence, one hematoma. There was no major complications. The concomitant use of laparoscopic umbilical hernia repair and abdominoplasty is a feasible approach to reduce the risks of umbilical devascularization. Especially in larger hernias and in patients with higher risk of recurrence.

Commentary on: Concomitant Abdominoplasty and Laparoscopic Umbilical Hernia Repair.

Commentary on: Concomitant Abdominoplasty and Laparoscopic Umbilical Hernia Repair.

Concomitant Abdominoplasty and Laparoscopic Umbilical Hernia Repair.

Umbilical hernia is a common finding in patients undergoing abdominoplasty, especially those who are postpartum with rectus divarication. Concurrent surgical treatment of the umbilical hernia at abdominoplasty presents a "vascular challenge" due to the disruption of dermal blood supply to the umbilicus, leaving the stalk as the sole axis of perfusion. To date, there have been no surgical techniques described to adequately address large umbilical herniae during abdominoplasty. To present an effective and safe technique that can address large umbilical herniae during abdominoplasty. A prospective series of 10 consecutive patients, undergoing concurrent abdominoplasty and laparoscopic umbilical hernia repair between 2014 and 2017 were included in the study. All procedures were performed by the same general surgeon and plastic surgeon at the Macquarie University Hospital in North Ryde, NSW, Australia. Data were collected with approval of our ethics committee. At 12-month follow up there were no instances of umbilical necrosis, wound complications, seroma, or recurrent hernia. The mean body mass index was 23.8 kg/m2 (range, 16.1-30.1 kg/m2). Rectus divarication ranged from 35 to 80 mm (mean, 53.5 mm). Umbilical hernia repair took a mean of 25.9 minutes to complete (range, 18-35 minutes). We present a technique that avoids incision of the rectus fascia minimizes dissection of the umbilical stalk and is able to provide a gold standard hernia repair with mesh. This procedure is particularly suited to postpartum patients with large herniae (>3-4 cm diameter) and wide rectus divarication, where mesh repair with adequate overlap is the recommended treatment.

Mesh migration into an inguinal hernia sac following a laparoscopic umbilical hernia repair

Mesh migration into an inguinal hernia sac following a laparoscopic umbilical hernia repair

A clinical study of laparoscopic versus open umbilical hernia repair

A clinical study of laparoscopic versus open umbilical hernia repair

Patient Satisfaction Following Laparoscopic Umbilical Hernia Repair Using a “Two-Port” Technique

NOTICE: THIS ARTICLE HAS BEEN RETRACTED. Background: Measuring patient satisfaction is important to help improve health service delivery and improve outcomes. The aim of this study is to evaluate patient satisfaction with laparoscopic umbilical hernia repair and determine overall satisfaction with referral, outpatient consultation, pre-assessment clinic attendance, and post-operative care. Methods: This was a retrospective study of 52 patients undergoing laparoscopic umbilical hernia repair. Each patient completed an extensive self-administered questionnaire distributed at a scheduled follow-up appointment 3 months following the operation. Results: The response rate was 86.5%. Most patients (77.8%) were referred from their general practitioner. Patient satisfaction with surgical outcome was very high at > 98%, and the overall patient satisfaction from being listed for surgery to discharge was > 95%. Patient satisfaction was significantly associated with the patient being referred to the hospital by a general practitioner (GP). Conclusions: Patient satisfaction is an important health outcome, and understanding the domains of satisfaction, as well as their relative importance to patients, is necessary to improve overall quality of patient care. Laparoscopic umbilical hernia repair using a “two-port” technique is an effective procedure with excellent results and an extremely high rate of patient satisfaction. J Curr Surg. 2017;7(4):49-52 doi: https://doi.org/10.14740/jcs333w

Laparoscopic Umbilical Hernia Repair Using a “Two-Port” Technique: A Single-Center Experience

Background: Laparoscopic umbilical hernia repair has gained popularity over the last decade. As an alternative to the classical three- to four-port laparoscopic technique, the two-port technique is reported to have the advantages of being the least minimally invasive umbilical repair procedure described to date. The aim of this study was to determine the operative outcomes of patients treated using the two-port umbilical hernia repair technique. Methods: This was a retrospective, single-center study. The case notes of 52 patients undergoing umbilical hernia repair between November 2015 and November 2016 via the two-port method were reviewed. Operative time and hospital stay were recorded. Data were analyzed using descriptive statistics. Results: The operating time was 32 min on average. There was no significant procedural blood loss, iatrogenic injury, or subcutaneous emphysema. No patient required conversion to conventional methods. All patients were comfortable in the postoperative period and were routinely discharged on the second postoperative day. Forty-five of the 52 cases completed 3-month follow-up without any reported complications. Conclusions: Excellent outcomes are possible using the two-port technique for umbilical hernia repair. However, proper patient selection and experience and proficiency in performing laparoscopic hernia repair are prerequisites for good outcomes. J Curr Surg. 2017;7(3):39-41 doi: https://doi.org/10.14740/jcs329w

A rare cause of intestinal obstruction: dual mesh migration into the small intestine following laparoscopic umbilical hernia repair

The laparoscopic approach is widely accepted worldwide for the management of Umbilical hernias. Here we report a case of intestinal obstruction due to migration of a composite dual mesh into the small intestine after laparoscopic umbilical hernia repair. A case was reported in which, a 50-year-old female patient presented in emergency department with 3 days history of constipation and a clinical picture of intestinal obstruction. She underwent laparoscopic umbilical hernia repair using dual mesh elsewhere 2 years back. As initial conservative management failed, emergency exploratory laparotomy was done which showed adhesions between the ileum and anterior abdominal wall and the mesh had migrated into the intestinal lumen and produced intestinal obstruction. The involved bowel was resected. It was concluded that mechanical small bowel obstruction is an uncommon and rare but possible complication after laparoscopic umbilical hernia repair using dual mesh.

Severe Hydronephrosis and Perinephric Urinoma with Rupture of Renal Fornix Secondary to Postoperative Urinary Retention following Laparoscopic Umbilical Hernia Repair.

Postoperative urinary retention (POUR) is a known complication following a variety of procedures, with a reported incidence of 2.1–3.8% in general surgery and up to 52% in anorectal surgery. We report a case of POUR in a female resulting in severe unilateral hydronephrosis with a perinephric urinoma due to a ruptured fornix. The extent of hydroureter caused an axial rotation upon itself producing further outflow obstruction. This phenomenon of an anatomical ureter deformity secondary to urinary retention resulting in a ruptured fornix is an unusual occurrence. The patient underwent a percutaneous nephrogram where a stiff guidewire was successfully passed into the bladder by interventional radiology (IR) and allowed for placement of an indwelling ureteral stent. The case presentation, diagnostic evaluation, and therapeutic intervention are discussed.

Randomized clinical trial on the postoperative use of an abdominal binder after laparoscopic umbilical and epigastric hernia repair.

Application of an abdominal binder is often part of a standard postoperative regimen after ventral hernia repair to reduce pain and seroma formation. However, there is lack of evidence of the clinical effects. The aim of the present study was to investigate the pain- and seroma-reducing effect of an abdominal binder in patients undergoing laparoscopic umbilical or epigastric hernia repair. Based on power analysis, a minimum of 54 patients undergoing laparoscopic umbilical and epigastric hernia repair were to be included. Patients were randomized to abdominal binders vs. no abdominal binders during the first postoperative week. Standardized surgical technique, anaesthesia, and analgesic regimens were used and study observers were blinded towards the intervention. Postoperative pain (visual analogue score) on day 1 was the primary outcome. In addition, ultrasonographic evaluation of seroma formation and several subjective patient-related parameters were registered. Furthermore, patients in the abdominal binder group were asked to rate benefits or discomforts of wearing the binder. Data from 56 patients (abdominal binder, n = 28; no binder, n = 28) were available for analysis. No significant intergroup differences in postoperative pain or any of the other surgical outcomes, including seroma formation, were found. However, the abdominal binder group reported subjective beneficial effect of wearing the binder in 24 of the 28 patients (86%). No adverse effects of the abdominal binder were found. There were no effects of an abdominal binder on pain, movement limitation, fatigue, seroma formation, general well-being, or quality of life. However, most patients claimed a subjective beneficial effect of using their abdominal binder.

Laparoscopic repair of a large umbilical hernia in a super obese woman and its outcome

The umbilical hernia is a common surgical problem mainly encountered in the 5th and 6th decades of life. The umbilical defect is observed in more than 90% of elderly patients. It is seen mainly in obese patients, especially in women. A 52-year-old super obese woman with body mass index 53.3 kg/m 2 presented with intermittent, crampy, abdominal pain. Laparoscopic umbilical hernia repair with combined herniorrhaphy and intraabdominal mesh fixation offers an efficient, safe, and effective repair for umbilical hernia in super obese women.

Laparoscopic Umbilical and Epigastric Hernia Repair

Laparoscopic Umbilical and Epigastric Hernia Repair

Fibrin sealant for mesh fixation in laparoscopic umbilical hernia repair: 1-year results of a randomized controlled double-blinded study

Fibrin sealant for mesh fixation has significant positive effects on early outcome after laparoscopic ventral hernia repair (LVHR) compared with titanium tacks. Whether fibrin sealant fixation also results in better long-term outcome is unknown. We performed a randomized controlled trial including patients with umbilical hernia defects from 1.5 to 5 cm at three Danish hernia centres. We used a 12 cm circular mesh. Participants were randomized to fibrin sealant or titanium tack fixation. Patients were seen in the outpatient clinic at 1 and 12 months follow-up. Forty patients were included of whom 34 were available for intention to treat analysis after 1 year. There were no significant differences in pain, discomfort, fatigue, satisfaction or quality of life between the two groups at the 1-year follow-up. Five patients (26 %) in the fibrin sealant group and one (6 %) in the tack group were diagnosed with a recurrence at the 1-year follow-up (p = 0.182) (overall recurrence rate 17 %). Hernia defects in patients with recurrence were significantly larger than in those without recurrence (median 4.0 vs. 2.8 cm, p = 0.009). Patients with larger hernia defects and fibrin sealant mesh fixation had higher recurrence rates than expected, although the study was not powered for assessment of recurrence. There was no significant difference between groups in any parameters after the 1-year follow-up. The beneficial effects of mesh fixation with fibrin sealant on early outcome warrant further studies on optimization of the surgical technique to prevent recurrence.